Paclitaxel concentrations in the brain are very low after intravenous injection. Since paclitaxel is excluded from some tumors by p-glycoprotein (p-gp), the same mechanism may prevent entry into the brain. In vitro, paclitaxel transport was examined in capillaries from rat brains by confocal microscopy using BODIPY Fl-paclitaxel. Western blots and immunostaining demonstrated apical expression of p-gp in isolated endothelial cells, vessels, and tissue. Secretion of BODIPY Fl-paclitaxel into capillary lumens was specific and energy-dependent. Steady state luminal fluorescence significantly exceeded cellular fluorescence and was reduced by NaCN, paclitaxel, and SDZ PSC-833 (valspodar), a p-gp blocker. Leukotriene C4 (LTC4), an Mrp2-substrate, had no effect. Luminal accumulation of NBDL-cyclosporin, a p-gp substrate, was inhibited by paclitaxel. In vivo, paclitaxel levels in the brain, liver, kidney, and plasma of nude mice were determined after intravenous injection. Co-administration of valspodar led to increased paclitaxel levels in brains compared to monotherapy. Therapeutic relevance was proven for nude mice with implanted intracerebral human U-118 MG glioblastoma. Whereas paclitaxel did not affect tumor volume, co-administration of paclitaxel (intravenous) and PSC833 (peroral) reduced tumor volume by 90%. Thus, p-gp is an important obstacle preventing paclitaxel entry into the brain, and inhibition of this transporter allows the drug to reach sensitive tumors within the CNS
Introduction Paclitaxel (Taxol) and derivatives are active against various tumors (1-6) and have also been used to treat malignant glioma and brain metastases (7-9). However, brain tumors constitute a difficult problem and the therapeutic benefit of paclitaxel has been variable and low. This could be attributed to its limited entry into the CNS. Although paclitaxel is very lipophilic, concentrations in the CNS are very low after intravenous administration (10, 11). Paclitaxel appears to be a substrate of the multidrug resistance protein p-gp (12-14), and it is likely that this transporter contributes to its limited access to the brain. P-gp is expressed in high levels in cultured brain capillary endothelial cells and in intact brain capillaries (15, 16). It is localized at the luminal surface of the endothelium (17, 18), and therefore is in the correct location to restrict permeation of a variety of drugs into the CNS (19-21). Animals with reduced p-gp function show an accumulation of p-gp substrates in the brain as well as a markedly increased sensitivity to neurotoxic p-gp substrates, e.g., ivermectin (18, 22, 23). The present study identifies in vitro a mechanism that limits paclitaxel access to the CNS and outlines a strategy to circumvent it by blocking p-gp. We demonstrated that the p-gp blocker valspodar enhances paclitaxel entry into the brains of mice after intravenous dosing and that valspodar dramatically increases paclitaxel effectiveness against a human glioblastoma implanted into the CNS of nude mice. These are the first data directly demonstrating the role of p-gp in limiting the therapeutic availability of paclitaxel to the CNS. Methods Chemicals. Valspodar (SDZ PSC 833) and the fluorescent cyclosporin derivative NBDL-CS were from Novartis Pharma GmbH
We recently demonstrated in isolated killifish renal proximal tubules that two classes of nephrotoxicants, aminoglycoside antibiotics and radiocontrast agents, rapidly decrease transport mediated by multidrug resistance protein 2 (Mrp2) by causing endothelin (ET) release and signaling through an ET B receptor and protein kinase C (PKC) Terlouw et al., 2001). In the present study, we used killifish proximal tubules, fluorescein methotrexate, a fluorescent model substrate for Mrp2, and confocal microscopy to examine the effects of two heavy metal salts (CdCl 2 and HgCl 2 ) on Mrp2 function.
To identify specific transporters that drive xenobiotics from the central nervous system to blood, the accumulation of fluorescent drugs was studied in isolated capillaries from killifish and dogfish shark brain using confocal microscopy and quantitative image analysis. In killifish brain capillaries, luminal accumulation of fluorescent derivatives of cyclosporin A and verapamil was concentrative, specific, and energy dependent (inhibition by KCN). Transport was reduced by PSC-833, but not by leukotriene C4, indicating the involvement of P-glycoprotein. The ability of capillaries to transport the cyclosporin A derivative was unchanged over 20 h, demonstrating the long-term viability of the preparation. Luminal accumulation of the fluorescent organic anions sulforhodamine 101 and fluorescein-methotrexate was also concentrative, specific, and energy dependent. Transport of these compounds was reduced by leukotriene C4, but not by PSC-833, indicating the involvement of a multidrug resistance-associated protein (Mrp). Similar results were obtained for isolated capillaries from dogfish shark. Immunostaining localized P-glycoprotein and Mrp2 to the luminal surface of the killifish brain capillary endothelium. These findings validate a new and long-lived comparative model for studying drug transport across the blood-brain barrier and, as in mammals, implicate P-glycoprotein and Mrp2 in transport from the central nervous system to blood in fish.
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